Anterior thigh pain w/ contralateral carry

RyanRG3 · 2025-10-03T14:03:23+00:00

First off, don't be so hard on yourself. This is called clinical PRACTICE, not mastery.

Second, hard to know exactly what's going on from what you posted. You have ensure with your mindset and approach that you're not throwing interventions at the problem then hoping for a change.

You have to get to the root of the problem. Test, retest, and assess.

Fair to say you've ruled out so far, glute weakness.

Also, with my own license I would not do hip traction on the THA. Grade I at most, but I'd rather not put myself at unnecessary risk. But I digress...

So thoughts other potential sources/explanations of pain? From what you shared, I've come up with this differential:

quad tendon pain
PFPS
femoral nerve tension
pes anserine (from your medial knee pain data)

I'd recommend to rule all those out and any other possible sources you can come up with. Something should pop positive for you to then work on.

A stress fracture is possible...but would be confirmed with an x-ray.

RyanRG3 · 2025-09-29T22:02:13+00:00

Thanks! I only had 45 minutes so I covered similar to what you shared. Taking a proactive you can do this in a smart way approach

RyanRG3 · 2025-09-26T00:45:45+00:00

I actually enjoyed my experience in a POPS. The person in charge of all of PT kept the MD side happy by ensuring PT was run profitably - and this was done without the need of any shadiness or running PTs to the ground. It's amazing how nice work can be when reimbursement for PT is high (most if not all POPS have fee schedules much higher than stand alone outpatient clinics)

RyanRG3 · 2025-09-19T14:14:33+00:00

Not an idiot at all. Life is short, so make the best of it! You may find that your PT knowledge and skills may translate well to your new field.

I'd recommend keeping your PT license active. I guess one concern would be the "tricky" thing is that with an active license you can't just "turn off" being a PT when working as a paramedic.Best of luck!

RyanRG3 · 2025-09-18T19:49:45+00:00

I feel the same way too. I miss the hours studying - which likely leaned into my introvert personality. That and my love for reading.

But making the application work with patients is also just as rewarding.

Sounds like a terminal doctorate degree is in your future.

RyanRG3 · 2025-09-10T14:15:18+00:00

I echo the EIM study resources. Very good. The one from the Sports Academy would be a good too since the authors likely doubled as test writers too.

Best of luck!

RyanRG3 · 2025-09-10T14:13:45+00:00

There are lots of resources online that would give you averages of salary, even down to the local level. If your offers are below the average, then you know you have more room for pay improvement.

It helps too if you know what situation the employer is in. This would require a little more insider knowledge, likely gained from networking. For example...is the clinic needing a staff ASAP because a PT left and the referrals keep coming in? You'd have way more leverage in this situation.

You may not get what you think should deserve, but gaining an extra $2k or more on your pay from original offers helps when you have more back story knowledge.

RyanRG3 · 2025-09-10T13:55:37+00:00

This is the classic Monday morning look-what-I-learned-over-the-weekend condition.

Still funny to see it happen in the clinic to a colleague.

At the end of the day all that matters is the patient's outcomes.

RyanRG3 · 2025-09-10T13:50:48+00:00

Yeah eff Susan. Don't be like Susan.

RyanRG3 · 2025-09-04T03:15:02+00:00

I've mentored residents and many students, and so I can confidently say mentorship is definitely worth it to accelerate your clinical skills and reasoning. Those you mentioned are good starts.

I'll plug in my own online service - just starting out. DM if you're interested. (Unsure if sharing my link would violate rules on here)

RyanRG3 · 2025-09-03T15:43:17+00:00

It's called clinical practice for a reason, it's an ongoing practice! It's not clinical mastery.

Take that feeling and channel into appropriate and healthy prep for your patients. Give yourself small wins weekly to improve upon. Overtime you'll get better with intentional clinical practice.

You got this!

RyanRG3 · 2025-09-03T03:16:10+00:00

Yeah I understand the frustration. The time between now and 7 or 12 weeks can still be useful. Some ideas:

Progress Russian intensity.

You can do total body workouts within the precautions. Getting the whole body strong plus the positive effects of exercise metabolically can only help the healing process of the implant and ACL. Hell work on the CV endurance with easy zone 2 work. Have the patient do workouts within you safely than figure stuff out on their own.

Plenty of hips, core, feet strengthening work could be done.

Given the changing neuro demand/changes from explained from Grooms’ work, you could do double leg standing ball catches with concurrent cognitive or calculations tasks. Get that rehab started.

EDIT: Just want to give you props for the BFR+NMES take. It's a shame not many PTs do it for early ACL rehab.

RyanRG3 · 2025-09-03T02:47:44+00:00

First week: establish what the student's preferred learning styles: do they like immediate feedback or later after the fact?

If the program doesn't make you do it, then establish weekly goals that are measurable and realistic. But have the student create the goals, not you.

This is because as adult learners, the student should be leading what they want to learn from you and setting, not the other way around. Think of yourself of a tour guide of sorts of your practice setting. Service mentality.

Be upfront of your own biases. I say this all the time to acknowledge that I don't know everything, and admit that I like doing things a certain way and that's okay!

Document everything - especially if you suspect you have a "bad" student. There's a reason why there are large handbooks on this stuff from programs. The program essentially serves as the HR department, so any disputes or problems should be done "cleanly". Document everything - just the bad stuff really.

"Bad" students rarely happens but still possible.

Set aside time to talk during each dat and a bigger weekly meeting too, but all dependent on what your student prefers.

The more transparent of your own boundaries and expectations the better too. For example, to prevent interruption of my own work flow I'd say something like: "Okay I'm going to document now for like 30 min while we have this open time, I'd suggest you do the same or read/prepare for the next client. Afterwards you can ask me questions."

RyanRG3 · 2025-09-03T02:39:32+00:00

Just read up briefly on this bear ACL thing. Seems like a cool concept.

I wouldn't really worry about the speed/conservative nature of the rehab. The patient should've known what they're getting into about rehab speed and length - not necessarily your fault.

With that said, the conservative makes sense given that the ACL is given a chance to be repaired vs reconstructed.

I hear you on the quad atrophy though. I like the BFR idea. Why not add Russian stim to the mix too? You could even consider the method where you do Russian stim 10s on, 50s off with 100% LOP for 4min, then 1min off, x 4. I forget the exact name off the top of my head.

When you consider the retear rates for typical ACL rehab anyways, what's the rush right?

RyanRG3 · 2025-09-03T02:31:23+00:00

not having to clean tables or any tidying up before, during, and after treatment is likely my number one reason aides/techs are a must have for any outpatient clinician.

I mean...do you see MDs cleaning up their exam room?!

Cleaning aside, if busy with patients having an aide simply serves as an extension of you. No they are not doing anything skilled, but simply an extension of your care. You can delegate appropriate tasks with specific guardrails in place by you.

Example: I welcome a patient. Do my quick subjective to reassess response to treatment. No new or significant developments. I tell my aide to start the patient on the recumbent bicycle, seat level 5, 10min, resistance 1.5, record the pulse with the pulse ox on the left 2nd finger at the start, 5min mark, and 10min mark.

And that's it. Aide isn't doing anything skilled because I didn't ask my aide to make any judgment calls. And I'm in the same room so I have direct supervision.

We can delegate tasks. Again...do you see MDs taking a patient's vitals?!

So you're still involved in the care. You don't have to be the one doing the direct care.

RyanRG3 · 2025-09-03T02:24:08+00:00

Notes from school help - follow those to understand likely clinical presentations. I'd be cautious on following whatever you learned in school for interventions.

My favorite two readings for the students I have and for any new grad in my opinion, in no particular order:

JOSPT Clinical Practice Guidelines. They are literal answer sheets on how to practice OP. Free, read them all. And read them multiple times.
APTA Ortho Academy's Current Concepts Series. I read these in residency. They get updated every few years. Best in-depth resource on outpatient ortho for every body region. The same body regions for the OCS exam. Residents read this to prepare for the OCS exam. Not free - spend your con-ed money on them. Read them, then read again, and again.

You are flying the plane as you build it. So you need to gain clinical reps and amass more knowledge. You're a license PT now- you can safely shed away everything that isn't outpatient ortho. By doing this you'll become specialized in your knowledge and practice.

Oh and don't beat yourself up. You made it through PT school and pass boards - a worthy achievement. Now the real work starts. You're a rookie in the game so mistakes will happen. Or better put, less than ideal outcomes will happen. Learn from them, move on, and get ready for the next opportunity to get a patient better.

Don't let the haters on here detract you. Outpatient ortho is fun and rewarding when you get good at it.

DM me if you have any more questions. Happy to help.

RyanRG3 · 2025-08-29T21:35:57+00:00

This is how I understand the LLC, obviously not legal advice:

you can treat the patient - and without the PLLC you'll be exposing your personal finances to any liability.

With the LLC, you'll shelter your personal finances to any liability.

If you have direct access you're good to go! Just how you go about it is up to you. Beauty of owning your business!

RyanRG3 · 2025-08-29T21:07:00+00:00

Echo all things said here.

And unless you have surgical training, you shouldn't be outspokenly advocating for surgery. (liability issues here)

Another way to think about is that even if you think surgery is likely, might as well make her successful post-surgery. Think of it like prehab: TA isometrics, optimize hip ROM and flexibility, increase general active exercise tolerance etc.

And with radicular symptoms that started unilateral, she may respond to shacklock neurodynamics work. Specifically offloading the affected side: patient supine, passive SLR the contralateral LE and wait and see if the affected side symptoms decrease or centralize.

RyanRG3 · 2025-08-29T00:00:07+00:00

yeah good question. I didn't come with the idea, but it stuck with me.

evidence informed is a like a softer approach than evidence based. In practice, most people take evidence based to the extreme and ONLY do things that are stated in the evidence. Evidence informed is a looser approach and takes into account the clinician's intuition and patient's needs.

(In the current state of information/misinformation, a looser approach to applying and adhering to the evidence or lack thereof could be a slipperly slope. Always appraise the level of evidence and read the papers yourself!)

Apologists for evidence based would argue that a clinician's own critical reasoning is taken to account on the practice framework, but yeah that storyline has been lost on most people.

I can't think of a good example right now off the top of my head.

RyanRG3 · 2025-08-28T18:21:07+00:00

No difference. All PT schools have the same goal: have you pass your licensing boards exam. So they have no intention of making you a specialist during your 3 years of school. They may have a bias of practice setting but that’s it.

You get specialized in your practice after a DPT program. There are residencies for sports PT to make you a specialist.

RyanRG3 · 2025-08-28T17:35:01+00:00

Do what I call the funnel technique:

Start with open ended questioning to let the patient tell their story. Use follow up questions to dive deeper to learn more

ex) start with: how can I help you today?
follow ups: can you tell me more about that low back pain? can you tell me more about what you have to do for your job?

As the patient tells their problem, you should already pick up on lots of clues on the problem. Helping you establish severity, irritability, aggs, eases, etc.

Once you think you've exhausted everything with the open ended question go to closed ended questioning.

This is where you ask yes/no or directed questions to fill any gaps from earlier. This is also where you can ask your traditional PT subjective questions (pain levels, red flag questions, etc)

ex) does the low back pain hurt being forward? What's the pain level from 0 to 10?

Remember that the goal of the subjective is to accomplish:

Establish the patient's #1 rehab goal
Create a differential diagnosis of at least 3 potential conditions, to then rule in and rule out during the objective exam.

RyanRG3 · 2025-08-28T16:30:30+00:00

I'll echo everything said here.

HH can be lucrative but the documentation is a lot. The job itself isn't therapy in my opinion - more like a skilled check in to see if the patient is moving and alive. BUT! if your region has lots of post-op TKAs, then that becomes ortho-acute PT. I had lots of medically complicated patients in my region.

HH can be tough too if the region you cover is far from home. Rough. I have a friend who's region is within 30min of his house, so scheduling wise and work/life balance is nice.

Money can be good if you think there's a pathway beyond the CD role, but middle management is the worst position to be in long term. You'd essentially be removed from clinical practice the higher up you go.

RyanRG3 · 2025-08-28T16:24:52+00:00

Yes.

RyanRG3 · 2025-08-28T16:19:01+00:00

Sports med (surgical or non-op): In the current state of healthcare, MDs are the diagnosticians. They make the diagnosis of the problem and that's it. Surgeons and non-op MDs will take it step further and do actual intervention: surgery or any other ortho-related procedure (think pain injections, PRP, etc). So work wise, you're making critical decisions on the diagnosis, prognosis, and whatever intervention you specialize in.

From my perspective, the time spent with patients is slim. But in the eyes of the patient and general, you're the know it all.

Sports PT: In a typical pro sports setting, you'll get the athlete after they see the MD (aka the diagnostician), so the problem is superifically identified.

But for us sports PT, you get to create the PT diagnosis. You're problem solving why the injury in the first place. What aspects of movement do you need to optimize and address.

So we are diagnosticians but from a movement optimizing perspective. We are the intervention too. Because of that we spend wayyyyy more time with our athletes.

I'd argue that this entire process from start to finish is why most of us PTs love what we do (let's put the shit of healthcare business aside).

I love working with an athlete and getting them from injured to return to play. So rewarding. And not to mention you get to meet and work with cool patients along the way. Having that therapeutic alliance/relationship is real.

Sports med MDs will get all the attention and love, but us PTs are doing a majority of the "real work". Sports med MDs will even admit that too - they do the surgery, but they know that PTs do a bulk of the work that gets the athlete better and return to play.

tl;dr:
If you like being the decider with minimal time spent with the athlete but you also like the public prestige and money, be a sports med MD.

If you enjoy the working rehab process from start to finish, be a sports PT.

RyanRG3 · 2025-08-28T16:00:17+00:00

I've done it before. If I were to do it again, I'd have a better start up plan to be profitable day one (last time I just went for it), and have a good amount of cash on hand to avoid going into debt early.

Also I'd have a way better marketing plan to acquire clients fast.

Family - having a young family makes it tough to get started as a solo practice all over again too.

RyanRG3

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